Factors Predicting Ineffective Contraceptive Use

项目摘要 意外怀孕（UP），定义为不合时宜或不想要的怀孕，是一个重要的和普遍的 公共卫生问题，特别是低收入妇女。据报道，超过一半的怀孕是 非预期的和UP与许多不良后果有关，包括抑郁症，物质使用， 产前护理延迟，以及对儿童健康的不利影响。正确和一致地使用有效的 避孕是预防UP的主要方法。2012年《平价医疗法案》规定， 然而，消除经济障碍并没有大大减少UP， 仅在临床访视期间发送消息并不能促进一致使用。我们和其他人报告说， 抑郁症状和低自尊与不一致的避孕使用和增加的风险有关。 然而，没有任何干预措施或信息解决避孕使用的这一障碍。因此，迫切需要 需要制定和评估干预措施，以减少抑郁症状，改善避孕措施的使用， 减少。 传统的认知行为疗法（CBT）在减轻抑郁症状方面是有效的;但有限 利用率、反应差和对CBT的依从性低是常见的。最近的一项荟萃分析表明， 在传递CBT信息时，将同行专家纳入其中最有利于减少抑郁症的发生。 症状，并保持低收入妇女的高参与率。本提案将审查 一项为期12周的同行专家领导的CBT干预的可行性和有效性， 控制病情，减少抑郁症状，提高自尊，提高避孕的一致性 用于预防年轻性活跃女性的UP。

Project Summary Unintended pregnancy (UP), defined as a mistimed or unwanted pregnancy, is a significant and prevalent public health problem, particularly among low-income women. Over one-half of all pregnancies are reported as unintended and UP has been linked to numerous adverse outcomes including depression, substance use, delayed prenatal care, and adverse child health outcomes. Correct and consistent use of effective contraception is the primary method to prevent UP. The Affordable Care Act of 2012 provides free contraception to women; however, removing financial barriers has not dramatically reduced UP and providing messages only during a clinical visit does not promote consistent use. We, and others, report that high depressive symptoms and low self-esteem are linked to inconsistent contraception use and increased risk of UP however, no interventions or messages address this barrier to contraception use. Thus, there is an urgent need to develop and evaluate interventions to decrease depressive symptoms, improve contraception use and reduce UP. Traditional cognitive behavioral therapy (CBT) is effective in reducing depressive symptoms; but limited utilization, poor response and low adherence to CBT is common. A recent meta-analysis suggests that incorporating peer-specialists in the delivery of CBT messages was most beneficial in reducing depressive symptoms and maintaining high participation rates among low-income women. This proposal will examine the feasibility and effectiveness of a 12-week peer-specialist led CBT intervention compared an observational control condition to reduce depressive symptoms, improve self-esteem and improve consistent contraceptive use to prevent UP among young sexually active women.